Can a pill stop you puffing?

[shahul]

There is no tablet or patch that will create willpower for you.

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The most important thing that will help you quit smoking is willpower

With the smoking ban in public places, some minds seem to have become focused. What will help us give up, some have asked - hypnotherapy, nicotine patches or the new tablet Champix?

The most important ingredient, if you are serious about giving up, is the one you can't buy, beg, borrow or steal: willpower. Unless you can think 'no' and say 'no' and are willing to undergo some physical or psychological discomfort, you will not succeed.

There is no tablet or patch that will create willpower for you. But supposing you have the motivation, where next? Add in some advice from a doctor to stop and quit rates are again improved.

Otherwise, however, medical advice is not very well taken, which either says something about the addictiveness of nicotine or the ineffectiveness of medical advice. In an ordinary year, four out of 100 smokers stop.

When a doctor spends a few moments giving 'brief advice' to give up, the quit rate rises to six per 100. Self-help books can help but not a lot - only by an extra one person per 100 per year.

Pharmaceutical help
Complement these with pharmaceutical help and quit rates do improve more visibly. There are a variety of delivery systems for nicotine - from patches to chewing gum to fake cigarettes.

Nicotine replacement almost doubles the chances of quitting - from 10 per cent with placebo to 17 per cent when the active nicotine replacement was used.

There are also non-nicotine treatments. Bupropion (trade name Zyban) was developed as an antidepressant but was noted in trials to have the unusual side effect of stopping some people from smoking.

You take it for a couple of weeks prior to your 'quit date' and then increase the dose as you stop smoking. After a couple of months you should be both smoke-free and tablet-free.

It works for some. The rate for stopping smoking with bupropion is similar to that of nicotine replacements, raising the success rate from 9 per cent with placebo to 19 per cent with the tablets. The problems with bupropion are twofold.

First, about 3 per cent of patients get a rash or sensitivity reaction to it and, second, there is a risk of seizures. Although the risk is small - about 1 in 1,000 - it means that people who are at higher risk of a seizure shouldn't take it.

Champix or varenicline, the newer drug recently provisionally approved by the National Institute for Health and Clinical Excellence, doesn't come with the caveat about seizures.

Additionally, it seems to work fairly well - in one trial, it had a quit rate of 23 per cent after a year compared with almost 15 per cent in the bupropion group and 10 per cent with placebo.

But varenicline does come with the risk of side effects, especially nausea. Also, concerns have been raised about how realistic the trial conditions are in the real world: will people get the same level of support?

So what are the treatments that don't work? Acupuncture and acupressure do not have enough evidence for recommendation. The same goes for hypnotherapy.

Training more health professionals to ask more people about their smoking habits doesn't make much difference. And there is not much evidence that using television or radio as a campaigning medium to deter young people from smoking helps either.

Intermittently, stories appear about nicotine vaccines. None is on the market yet but the concept is ideal - immunise yourself against the pleasures of nicotine and there is no desire or craving to smoke.

The same principle is being used to attempt to develop vaccines for other addictive drugs but I am not holding my breath for them to become available soon.

The best interventions to stop smoking are those offered, discussed and decided individually. With lavish helpings of willpower, of course.